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Intensive care admission criteria for traumatic brain injury patients across Europe.

Accepted version
Peer-reviewed

Type

Article

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Authors

Volovici, Victor 
Citerio, Giuseppe 
Stocchetti, Nino 
Haitsma, Iain K 

Abstract

Within a prospective, observational, multi-center cohort study 68 hospitals (of which 66 responded), mostly academic (n = 60, 91%) level I trauma centers (n = 44, 67%) in 20 countries were asked to complete questionnaires regarding the "standard of care" for severe neurotrauma patients in their hospitals. From the questionnaire pertaining to ICU management, 12 questions related to admission criteria were selected for this analysis. The questionnaires were completed by 66 centers. The median number of TBI patients admitted to the ICU was 92 [interquartile range (IQR): 52-160] annually. Admission policy varied; in 45 (68%) centers, patients with a Glasgow Come Score (GCS) between 13 and 15 without CT abnormalities but with other risk factors would be admitted to the ICU while the rest indicated that they would not admit these patients routinely to the ICU. We found no association between ICU admission policy and the presence of a dedicated neuro ICU, the discipline in charge of rounds, the presence of step down beds or geographic location (North- Western Europe vs. South - Eastern Europe and Israel). Variation in admission policy, primarily of mild TBI patients to ICU exists, even among high-volume academic centers and seems to be largely independent of other center characteristics. The observed variation suggests a role for comparative effectiveness research to investigate the potential benefit and cost-effectiveness of a liberal versus more restrictive admission policies.

Description

Keywords

CENTER-TBI, Cost-effectiveness, European policy, Intensive care admission, Intensive care occupancy, Moderate and Severe TBI, Brain Injuries, Traumatic, Cohort Studies, Cost-Benefit Analysis, Critical Care, Europe, Hospitalization, Humans, Intensive Care Units, Israel, Patient Admission, Prospective Studies, Surveys and Questionnaires, Trauma Centers

Journal Title

J Crit Care

Conference Name

Journal ISSN

0883-9441
1557-8615

Volume Title

49

Publisher

Elsevier BV
Sponsorship
European Commission (602150)
EU FP7 grant